Cigna insurance CEO David Cordani says the Centers for Medicaid and Medicare Services' recent payment changes that emphasize quality over quantity in healthcare will shift the focus on "sick care to more well care." But a widespread embrace of diet, fitness and other wellness programs is still a way off,

"As a country, we're in a transitional state in many ways," he says.

Aetna's Joseph Zubretsky agrees. Hospitals and insurers have been focusing on changing how they pay for health care and using technology and clinical services to help track and manage that care, he says Accountable Care Organizations, which are groups of doctors and often hospitals that unite to keep a population of patients well, are a big part of the push.

"Our vision for ACO 2.0 will add more emphasis on wellness," says Zubretsky, who is senior executive vice president for Aetna's Healthagen division. "We need to find new ways to support and encourage people to get well and stay well, and that will open doors to a whole range of services as we work together with providers to search for what works best for different people."

Cigna is already working closely with its corporate clients on wellness programs that involve many of the kinds of preventive efforts community groups, such as the YMCA, are working on.

"That conversation has not been a broad conversation but it's changing largely from the business community," says Cordani.

Cigna encourages its corporate clients to add healthier foods to cafeterias and subsidize these foods when possible and to encourage walking and other activity on the job, says Cordani, who has done about 125 marathons and triathlons,

Emphasizing wellness has helped its employers improve attendance and job satisfaction, which reduces both turnover and healthcare costs, Cordani says.

In many cities, Cigna is paying for doctors to have health coaches, nutritionists and other resources in their offices to "provide more comprehensive care management.". But it doesn't work with all physicians' offices.

"You have to do it with like minded physicians who really want to engage differently," says Cordani.

Cigna's Healthspring division has done that for about 10 years in many cities including Miami and Houston for its Medicare Advantage plans. Starting this year, some of Cigna's plans on the Obamacare exchanges offer consumers the option to choose plans that include doctors who work closely with health coaches and nutritionists.

Insurers should cover "new wellness- and prevention-oriented treatments such as yoga and meditation, Sukanya Soderland, a partner in consulting firm Oliver Wyman's health practice, wrote recently in the Harvard Business Review. She cited Aetna's decision to offer mindfulness and yoga training to 6,000 of its employees, which lowered and improved productivity by 69 minutes a week.

Aetna considers nutritional counseling medically necessary for chronic diseases such as heart disease and diabetes when it has a therapeutic role, is prescribed by a physician and provided by a licensed nutritionist, registered dietitian, or other qualified licensed professional, according to the company's policy.

Still, insurance coverage for programs like those at KentuckyOne Health's Healthy Lifestyle Centers Louisville is generally pretty good for people with qualifying heart conditions, but not for those with diabetes, obesity, chronic pain or other conditions, says Alice Bridges, KentuckyOne's vice president of healthy communities,